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BACKGROUND Researchers and clinicians have typically relied on retrospective reports to monitor suicidal thoughts and behaviors. Smartphone technology has made real-time monitoring of suicidal thoughts possible via mobile ecological momentary assessment (EMA). However, little is known about how information gleaned from EMA compares with that obtained by retrospective reports. The authors sought to compare suicidal ideation (SI) assessed over 1 week using EMA with a retrospective gold-standard interviewer-administered measure covering the same period. METHODS Fifty-one adults with major depressive disorder completed 1 week of EMA (6×/day) assessing SI. Following completion of EMA, participants completed an interviewer-administered Scale for Suicide Ideation (SSI) retrospectively assessing the same week. RESULTS SI severity assessed through EMA was positively correlated with scores on the retrospective SSI. However, 58% of participants reporting ideation with EMA denied any past-week ideation on the SSI. Participants who endorsed SI during EMA but not on the SSI were no less likely to have a history of suicidal behavior than those who reported SI in both formats. CONCLUSION EMA captures instances of suicidal thinking that go undetected through retrospective report and thereby may help us to identify an at-risk subgroup otherwise missed.

Background Identifying brain activity patterns that are associated with suicidal ideation (SI) may help to elucidate its pathogenesis and etiology. Suicide poses a significant public health problem, and SI is a risk factor for suicidal behavior. Methods Forty-one unmedicated adult participants in a major depressive episode (MDE), 26 with SI on the Beck Scale for Suicidal Ideation and 15 without SI, underwent resting-state functional magnetic resonance imaging scanning. Twenty-one healthy volunteers (HVs) were scanned for secondary analyses. Whole brain analysis of both amplitude of low-frequency fluctuations (ALFFs) and fractional ALFF was performed in MDE subjects to identify regions where activity was associated with SI. Results Subjects with SI had greater ALFF than those without SI in two clusters: one in the right hippocampus and one in the thalamus and caudate, bilaterally. Multi-voxel pattern analysis distinguished between those with and without SI. Post hoc analysis of the mean ALFF in the hippocampus cluster found it to be associated with a delayed recall on the Buschke memory task. Mean ALFF from the significant clusters was not associated with depression severity and did not differ between MDE and HV groups. Discussion These results indicate that SI is associated with altered resting-state brain activity. The pattern of elevated activity in the hippocampus may be related to how memories are processed.

INTRODUCTION: We tested the relationship between genotype, gene expression and suicidal behavior and major depressive disorder (MDD) in live subjects and postmortem samples for three genes, associated with the hypothalamic-pituitary-adrenal axis, suicidal behavior, and MDD; FK506-binding protein 5 (FKBP5), Spindle and kinetochore-associated protein 2 (SKA2), and Glucocorticoid Receptor (NR3C1). MATERIALS AND METHODS: Single-nucleotide polymorphisms (SNPs) and haplotypes were tested for association with suicidal behavior and MDD in a live (N = 277) and a postmortem sample (N = 209). RNA-seq was used to examine gene and isoform-level brain expression postmortem (Brodmann Area 9; N = 59). Expression quantitative trait loci (eQTL) relationships were examined using a public database (UK Brain Expression Consortium). RESULTS: We identified a haplotype within the FKBP5 gene, present in 47% of the live subjects, which was associated with increased risk of suicide attempt (OR = 1.58, t = 6.03, P =.014). Six SNPs on this gene, three SNPs on SKA2, and one near NR3C1 showed before-adjustment association with attempted suicide, and two SNPs of SKA2 with suicide death, but none stayed significant after adjustment for multiple testing. Only the SKA2 SNPs were related to expression in the prefrontal cortex (pFCTX). One NR3C1 transcript had lower expression in suicide relative to nonsuicide sudden death cases (b = -0.48, SE = 0.12, t = -4.02, adjusted P =.004). CONCLUSION: We have identified an association of FKBP5 haplotype with risk of suicide attempt and found an association between suicide and altered NR3C1 gene expression in the pFCTX. Our findings further implicate hypothalamic pituitary axis dysfunction in suicidal behavior.© 2016 Wiley Periodicals, Inc. Language: en

Background Low gamma-aminobutyric acid (GABA) is implicated in both anxiety and depression pathophysiology. They are often comorbid, but most clinical studies have not examined these relationships separately. We investigated the relationship of cerebrospinal fluid (CSF) free GABA to the anxiety and depression components of a major depressive episode (MDE) and to monoamine systems.

The Institute of Medicine’s (IOM) report on psychosocial interventions challenges us to think not only about the way we study and deliver these important treatments, but also the way we teach and implement them. The report’s emphasis on protecting consumers by ensuring that effective psychosocial interventions are delivered in forms that closely approximate the ones for which the evidence exists has major implications for recruitment and training of faculty, didactic and supervisory teaching methods, competency standards held by national accreditation organizations, and research training. We briefly outline each of these issues below. Perhaps, the real game-changing suggestion of the report is that psychosocial interventions be delivered, taught, and researched using an “elements approach.” In its most radical form, this model, which is somewhat analogous to dimensional model of psychopathology taken by the NIMH’s Research Domain Criteria (RDoC), identifies elements that are both effective and common to multiple types of psychotherapy so that these elements can be studied, taught, and delivered a la carte. This is an exciting and challenging way to conceptualize psychosocial interventions that would require an entirely new approach to training. Curricula would cease to consist of separate courses and supervisors for each type of treatment, instead of employing a single “psychosocial interventions” course that would teach each of the effective elements and how and when to use them. Faculty trained in each of the psychotherapies would have to be retrained in the elements approach, with new or harmonized terminology and an “un-silo-ing” of their approach to assessment, treatment, and formulation. This could be difficult, as loyal practitioners of different psychotherapies often mix as well as oil and water. Even if psychotherapies continued to be delivered and taught in their extant forms, beginning to think about the effective elements of these interventions could prompt new and innovative ways to teach these common elements, much as we teach factors such as therapeutic alliance, empathic listening, and maintaining frame/boundaries as being common to all forms of therapy. The elements approach would also require new directions for psychotherapy research training, with requisite reframing for established psychotherapy research mentors. Beyond the discussion of the elements approach, the major thrust of the report is the importance of delivering psychosocial interventions that maintain fidelity to the effective form for which evidence exists. Sadly, much is often lost in translation, leading to less than ideal health care delivery. Changing this for psychosocial interventions will require increased attention to quality measures, as well as altering training in the following domains.

Background Brain serotonin-1A receptors (5-HT1A) are implicated in anxiety. We compared regional brain 5-HT1A binding in medication-free participants with posttraumatic stress disorder (PTSD) and healthy volunteers using fully quantitative positron emission tomography (PET) methods.

The literature regarding risk factors for suicidal behavior in the context of major depressive episode is reviewed. An organized framework for prevention strategies is provided. Risk factors for suicide in major depression can be organized according to whether their effect is on the threshold for suicidal acts or whether they serve mainly as triggers or precipitants of suicidal acts. For patients sufficiently depressed to present for evaluation and treatment, severity of depression is a poor guide to risk for suicidal acts. The best predictors relate to the threshold or predisposition to suicidal acts in response to major depression. Although available literature on suicidal behavior focuses on major depression in general, the findings may be usefully applied in refractory depression. Guidelines for assessment and management of suicidal behavior in major depression are offered. Depression and Anxiety 5:202–211, 1997. © 1997 Wiley-Liss, Inc.